Provider Demographics
NPI:1457840605
Name:SIARD, MARIO DOMINICK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:DOMINICK
Last Name:SIARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 OLD ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6992
Mailing Address - Country:US
Mailing Address - Phone:724-493-6923
Mailing Address - Fax:724-836-5565
Practice Address - Street 1:298 OLD ROUTE 30
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6992
Practice Address - Country:US
Practice Address - Phone:724-493-6923
Practice Address - Fax:724-836-5565
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor